Social Psychology of Education

https://doi.org/10.1007/s11218-021-09626-x

Girls suffer: the prevalence and predicting factors

of emotional problems among adolescents during upper
secondary school in Norway

Jan Arvid Haugan1 · Per Frostad1 · Per‑Egil Mjaavatn1

Received: 7 September 2020 / Accepted: 26 February 2021

© The Author(s) 2021

Abstract
This longitudinal, quantitative survey examined factors predicting 1077 Norwegian
adolescents` emotional problems during Upper Secondary School (grades I–III,
approximately 16–19 years old) considering the following research question: “To
what extent do students in Upper Secondary School experience emotional problems,
and how are these problems predicted by gender, academic/social self-concept, cop-
ing beliefs, appearance pressure and school stress?”. The mentioned variables were
scrutinized through analysis of frequencies, zero order correlations and structural
equation modeling. Results verified previous findings that there was an increase in
emotional problems for adolescents, especially among girls. Furthermore, the study
results indicate that coping beliefs is a crucial factor when it comes to the percep-
tion of pressure and stress, and the subsequent development of emotional health
problems.

Keywords Emotional problems · Coping beliefs · Stress · Gender

1 Introduction

Mental health problems are a matter of major public health concern and are among
the leading contributors to the health burden for children and adolescents glob-
ally (Erskine et al., 2015; Whiteford et al., 2013). The literature usually separates
between mental problems and disorders. Mental health problems refer to symptoms

* Jan Arvid Haugan

[email protected]
Per Frostad
[email protected]
Per‑Egil Mjaavatn
[email protected]
1
Department of Education and Lifelong Learning, Norwegian University of Science
and Technology, NO‑7491 Trondheim, Norway

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 J. A. Haugan et al.

that have significantly negative impact on well-being, learning, daily tasks and
socializing with others, while they do not satisfy the criteria for a psychiatric diag-
nosis (Mykletun et al., 2009). A mental disorder can be assessed when the symp-
toms are in coherence with the criteria in a diagnostic system, such as ICD10 (World
Health Organization, 2018) or DSM-5 (American Psychiatric Association, 2013).
Mental health disorders are concluded by health personnel based on diagnostic inter-
views, while it is common to identify the extent of mental health problems through
the use of questionnaires. In the following we refer to mental health problems when
we discuss mental health among adolescents.
About 10–20% of children and adolescents in the world suffer from mental health
problems (Henderson et al., 2017; Kieling et al., 2011). This can have serious con-
sequences for the quality of life as mental health problems during adolescence are
related to weak academic and social functioning (Balazs et al., 2013; Rasing et al.,
2020). Studies of prevalence from the 80s into the 21st century suggest a global
increase in both mental health problems and disorders, especially internalized symp-
toms among girls (Bor et al., 2014; Choi, 2018). This tendency is supported by stud-
ies from the USA (Merikangas et al., 2010), the UK (Collishaw, 2015) and other
countries in the western world (Auerbach et al., 2018). These circumstances have
led to strengthened emphasis on how teachers, counsellors and the school as a whole
can reduce contextual stressors and facilitate adolescents` ability to cope with life
challenges. Based on this, research on risk- and protective-factors connected to cop-
ing has increased in the last few decades.
Coping is defined as the “constantly changing cognitive and behavioral efforts
to manage specific external and/or internal demands that are appraised as taxing or
exceeding the resources of the person” (Lazarus and Folkman, 1984, p. 141). How-
ever, coping factors cannot be reduced to purely individual, psychological traits
(Condly, 2006; Herrman et al., 2011). Other definitions emphasize the ecological
influence on coping, stating that risk- and protective-factors include: “(…) both the
capacity of individuals to navigate their way to health-sustaining resources (…) and
a condition of the individual`s family, community and culture to provide these health
resources and experiences in culturally meaningful ways” (Ungar, 2008, p. 225).
This ecological perspective on coping is supported by research indicating that the
quality of relationships with significant others is of considerable importance (Cur-
rie et al., 2012; Lerner, et al., 2005), in addition to broader environmental factors
such as a safe and inclusive classroom environment (Skaalvik and Skaalvik, 2013;
Theron, 2016).
In the present study, we will demarcate the scrutiny of risk- and protective-factors
to the associations between self-concept, coping beliefs, appearance pressure, school
stress, and emotional problems. These are all individual perceptions, and we recog-
nize that coping encompasses a dynamic, bi-directional process in which the envi-
ronment and the individual interacts constructively over time. In such, contextual
factors in both proximal microsystems (e.g. family, school, friends) and in the more
distal macrosystems (e.g. politics, culture) affect coping during adolescence (Lerner
et al., 2005, Ungar, 2008). However, numerous findings also indicate that individu-
als` cognitive perceptions and interpretations are important when understanding the
development of stress, perceptions of pressure, and mental health problems (e.g.

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Girls suffer: the prevalence and predicting factors of emotional…

Fletcher and Sarkar, 2013; Jongen, McCalman and Bainbridge, 2019). From the per-
spective of Lazarus and Folkman’s (1984) transactional stress model, adolescents`
emotional problems depend not only on the objective challenges or stressors they
are exposed to, but also on how they subjectively evaluate the situation and beliefs
in their own ability to handle it. Thus, their transactional model of stress claims, in
line with other research (e.g. Sowislo and Orth, 2013; Yeoh et al., 2017), that self-
concept and coping beliefs are decisive constructs to predict experiences of stress
and subsequent emotional problems. Individuals with high levels of coping beliefs
are more likely to view difficult tasks as challenges rather than things to be avoided.
Thus, they are more likely to experience less distress and, and subsequently, fewer
emotional problems (e.g. Bandura et al., 1999; Orth et al., 2014).
In the following, we will review research on the associations between adoles-
cents’ perceptions of emotional problems, self-concept, coping beliefs, appear-
ance pressure and school stress. This literature review will end with a formulation
of a primary research question with six related hypotheses. In the next section we
describe methodological aspects, including descriptions of the participants and our
procedure, instruments and data analysis. Thereafter, we present findings and dis-
cuss the self-reported experience of Norwegian Upper Secondary School students
in light of earlier research and theory. This is followed by a discussion of the limita-
tions with the study, practical implications and future directions for research. The
article ends with conclusive remarks.

2 Literature review

2.1 Self‑concept

Numerous studies have found that mental health is linked to the experience of self-
concept during adolescence (e.g. McCarty et al., 2007; Ohannessian et al., 1999). In
the literature, self-concept is generally defined as a person`s perceptions and evalua-
tions of personal qualities, abilities, and knowledge (Esnaola et al., 2020; Ohannes-
sian et al., 2019), in academic, physical, and social domains (Hankin et al., 2015;
Van Keyserlingket al., 2019). The literature expresses increasing evidence that sup-
ports a multidimensional perspective of self-concept, often based on Shavelson,
Hubner and Stanton`s (1976) multidimensional, hierarchical, and domain-specific
model of self-concept, divided into academic and non-academic components. Aca-
demic self-concept is further divided into self-concepts in particular subject areas
(Mathematics, English, etc.) and non-academic self-concept is divided into social,
emotional, and physical self-concepts. This is supported by Marsh and Craven
(1997) who argue that “specific domains of self-concept are more useful than a gen-
eral domain” (p. 191) in order to understand the complexity, predict a wide variety
of behaviors, relate self-concept to other constructs, and provide outcome measures
for diverse interventions in educational settings.
Previous research indicates that self-concept is an important mediator factor for
psychological, social, behavioral and educational outcomes, such as personal devel-
opment, socialization processes, motivation, coping beliefs, perceptions of stress,

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 J. A. Haugan et al.

and mental health (Craven and Marsh, 2008; Marsh and Martin, 2011). Taking into
account the multidimensionality nature of the self-concept, it is necessary to explore
the predictive effects on mental health across several dimensions as the developmen-
tal patterns may differ. In this study we will emphasize two of these dimensions:
academic self-concept and social self-concept.
Academic self-concept is related to learners` knowledge and perceptions about
themselves in overall academic domains (Marsh and Martin, 2011; Wigfield and
Karpathian, 1991). Marsh (1989) found that the academic self-concept reaches its
lowest point in grades 8 or 9 and subsequently increases through late adolescence,
while other studies have found a consistent decline during secondary education
(De Fraine et al., 2007; Nagy et al., 2010). Some studies conclude that males score
higher than females (De Fraine et al., 2007; Pinxten, et al., 2013), while others find
an advantage for females (Young and Mroczek, 2003), or report no significant dif-
ferences (Esnaola et al., 2018; Marsh et al., 2005). Few studies have investigated the
development of social self-concept. However, some studies have found that lower
social self-concept is associated with increased emotional problems during mid-late
adolescence (Kim-Spoon et al., 2012; Lee et al., 2010).
Based on these findings, it is relevant to underline that Shavelson et al., (1976)
emphasized the importance of self-attributions, and suggested that forms of behav-
ior and dimensions of self-concept have correlated and reciprocal relations. This is
supported by Marsh and Craven (2006) who reviewed research on academic out-
comes and academic self-concept. They found the correlation between academic
self-concept and academic achievement (e.g. school grades) to have the strongest
association. However, they could not find correlations between other non-academic
components of self-concept and academic outcomes, underlining the multidimen-
sionality of the construct (Marsh and Martin, 2011). In sum, the above-mentioned
findings indicate that both academic self-concept and social self-concept are directly
and positively related with coping beliefs, and negatively related to emotional prob-
lems (Craven and Marsh, 2008; Marsh and Martin, 2011).

2.2 Coping beliefs

In a systematic review and structural equation modeling meta-analysis of 19 studies,

Groth et al. (2019) found that coping is predicted by coping beliefs and subsequently
predicts mental health outcomes. Four longitudinal studies indicated that coping
beliefs were significantly associated with eating problems (Halvarsson-Edlund et al.,
2008), anxiety (Lopez and Little, 1996; Weigold and Robitschek, 2011), and depres-
sion (Pérez et al., 2009). Furthermore, in light of their findings, Groth et al. (2019)
suggest that individuals who report low coping beliefs tend to underestimate the
potential positive consequences of their behavior and the likelihood to be rewarded
for this behavior. These findings can be interpreted in light of the theory of learned
helplessness (Abramson et al., 1978), which claims that learned helplessness occurs
when individuals do not experience that highly desired outcomes are contingent on
their responses. This may lead to an attribution of challenges and demands as uncon-
trollable, prompt individuals to use maladaptive coping strategies, such as self-pity,

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and thereby a predisposition toward reactive depression when experiencing failure

or negative life events (Lazarus and Folkman, 1984; Rotter, 1966). In this study, we
will use the concept of coping competence as an indicator of coping beliefs. Cop-
ing competence is defined as a belief in the capacity to “(…) effectively cope with
failure and negative life events as indicated by a reduced likelihood of helplessness
reactions and fast recovery from any occurring helplessness symptoms” (Schroder
and Ollis, 2013, p. 288). From this perspective, coping beliefs (competence) is
understood as a component of emotional well-being and resilience against learned
helplessness dispositions and helplessness-based reactive depression.
In sum, coping beliefs seems to be crucial for both the individuals` interpreta-
tion of the threat level, their own abilities and possible coping strategies. When the
expectation of coping is low, various challenges, demands and changes that we are
exposed to will eventually be perceived as stressful, while high coping will make us
more robust to cope with challenges we face in life and thus reduce the likelihood
that we will experience challenging situations as stressful. Based on this, we expect
that coping beliefs is directly and negatively related to perceptions of school stress,
appearance pressure and emotional problems (Sowislo and Orth, 2013; Yeoh et al.,
2017).

2.3 Appearance and school stress

This article investigates the associations between emotional problems and ado-
lescents’ perceptions of performance-related stress in two areas: appearance and
school. According to a study that compared the student reports on the perceptions
of school pressure between 1994 and 2010, the level of perceived pressure did not
increase during the period, except for a temporary uptake between 2002 and 2006.
However, recent research indicates that the prevalence of adolescent experience of
school stress has increased during the last decade (Bakken et al., 2018; Löfstedt
et al., 2019), and that there is a clear association between school stress and emo-
tional problems (Låftman and Modin, 2012; Ringdal et al., 2020).
In a systematical review of 33 studies, Lillejord et al. (2017) report mixed find-
ings concerning gender differences in school stress. Some studies find no differences
(Coelho and Romão, 2016; Sotardi, 2016), while most studies find that girls report
higher levels of stress compared with boys (Goldstein et al., 2015; Seiffge-Krenke,
2012; Sun et al., 2013; Yang and Cheng, 2016). To explain the differences, Lillejord
et al. (2017) argue that girls undergo more pubertal changes than boys, emphasize
social demands to a greater extent, become more stressed by unclear expectations
and more frequently experience school-related burnout. In line with this, Samela-
Aro and Tynkkynen (2012) point to research that has found that girls and boys expe-
rience stress differently. Girls internalize symptoms such as depression or fatigue
and develop a feeling of not coping with pressure. In addition, girls are more likely
to experience competitive situations and that they are more exposed to the nega-
tive effects of stress, while boys may tend to develop an externalized reaction pat-
tern such as adapting a cynical attitude toward school. This finding is supported by
Suldo and Shaunessy-Dedrick (2013) and Wahab et al. (2013). In sum, it seems that

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girls are more influenced by the school context than boys (Dalen, 2014; Låftman
et al., 2013). In the high-performing school context that Låftman et al. (2013) report
from, students believe that there is a culture of stress at school and that the students,
especially girls, influence each other and exaggerate the stress. This is confirmed
by Sonmark et al. (2016), who found that being surrounded by classmates who feel
pressured is more detrimental to the mental health of girls than boys.
Furthermore, there is an extensive research tradition on adolescents` attitudes
toward their own body and appearance. Studies show that girls have a more prob-
lematic body image than boys (Bakken et al., 2018; Skaalvik and Federici, 2015).
Also, these gender differences increase beyond adolescence (Bearman et al., 2006;
Jónsdóttir et al., 2008), and are more closely related to self-concept among girls than
boys (Alm and Låftman, 2018). Dissatisfaction with one`s own body and appear-
ance has a stronger association with mental health problems among girls than boys
(Hargreaves and Tiggeman, 2003; Bearman and Stice, 2008). In sum, based on these
findings, we expect that both appearance pressure and school stress are directly and
positively related with emotional problems.

2.4 The present study

The present study was designed to explore how students perceive life in school
in general, and the extent of emotional problems in particular. Even though men-
tal health and well-being are becoming a health priority in most western countries,
evidence concerning the prevalence and predictive factors over time remains mixed
(Cosma et al., 2020; Rasing et al., 2020). Thus, this longitudinal study is designed to
contribute to this knowledge gap in the literature. Based on the literature review, the
following research question was formulated: “To what extent do students in Upper
Secondary School experience emotional problems, and how are these problems
predicted by gender, academic/social self-concept, coping competence, appearance
pressure and school stress?”. Based on this research question and our findings from
the literature review, six hypotheses were formulated, and a theoretical path model
was specified:

• H1: The extent of emotional problems among adolescents has increased (Bor
et al., 2014; Choi, 2018).
• H2: Academic self-concept is directly and positively related with coping compe-
tence, and negatively related to emotional problems (Craven and Marsh, 2008;
Marsh and Martin, 2011).
• H3: Social self-concept is directly and positively related with coping compe-
tence, and negatively related to emotional problems (Kim-Spoon, Ollendick and
Seligman, 2012; Lee, Hankin and Mermelstein, 2010).
• H4: Coping competence is directly and negatively related with school stress,
appearance pressure and emotional problems (Abramson et al., 1978; Schroder
and Ollis, 2013)
• H5: Appearance pressure is directly and positively related with emotional prob-
lems (Alm and Låftman, 2018; Bearman and Stice, 2008).

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Girls suffer: the prevalence and predicting factors of emotional…

• H6: School stress is directly and positively related with emotional problems
(Låftman and Modin, 2012; Ringdal et al., 2020).

3 Method

3.1 Participants and procedure

This study was part of a larger data collection and analysis of students` perceptions
of their life in school. The sample for the present article comprises 1077 students
(56% response rate), 606 girls and 471 boys, through Upper Secondary School
(grades I–III, approximately 16–19 years old), from both rural and urban areas in
thirteen schools from one county in Norway. Data can be described as a convenience
sample (McQueen and Knussen, 2006), and were collected in the fall of 2015 (USI),
spring of 2017 (USII), and spring of 2018 (USIII).
The participating students were informed in advance that the participation in the
study was voluntary and that they were considered to have given their consent by
filling in the questionnaire. The data were collected with paper-based questionnaires
and administrated by members of the research team according to the guidelines of
the Norwegian Social Data Services. The Norwegian Data Inspectorate approved
the survey.

3.2 Instruments

The dependent variable was measured on a three-point scale ranging from “Not
true” (0), “Somewhat true” (1), and “Certainly true” (2). The independent variables,
except grades from Lower Secondary School (0–6) and Appearance Pressure (1–4),
were measures with items answered on a six-point Likert scale ranging from 1=
very untrue to 6= very true, and the reliability was measured by Cronbach`s alpha.

3.2.1 Emotional problems

The dependent variable Emotional Problems scale was constructed from the
Strength and Difficulties Questionnaire (SDQ). SDQ (Goodman, 1997, 1999) is a
brief assessment of mental health problems that consist of 25 questions covering
emotional symptoms, conduct problems, hyperactivity-inattention, and peer prob-
lems as well as prosocial behavior. SDQ was originally constructed for children
between 11 and 16 but has recently been used in older age groups (e.g. Bøe et al.,
2016; Vugteveen et al., 2019). SDQ Emotional Problems were measured by five
statements that each were scored from 0 to 2, making a possible score from 0 to 10.
Examples of statements: “I worry a lot”, “I am often unhappy, down-hearted or tear-
ful”. Cronbach`s alpha for the scale was good for both girls (.71) and boys (.73).

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3.2.2 Academic self‑concept

Academic self-concept was measured by four items based on the “Self-Description

Questionnaire III (SDQIII), originally developed by Marsh (1992), and acknowledged
as a leading multidimensional self-concept instrument for adolescents (e.g. Boyle,
1994; Hattie, 1992). Examples of statements: “I cope with the challenge of learning
new material at school”, “When I sit down to learn something really difficult, I can
handle it”. Cronbach`s alpha for the scale was good for both girls (.89) and boys (.86).

3.2.3 Social self‑concept

Social self-concept was also measured by four items based on the SDQIII (Marsh,
1992). Examples of statements: “It is easy for me to make friends”, “Most people like
me”. Cronbach`s alpha for the scale was good for both girls (.84) and boys (.87).

3.2.4 Coping beliefs

Coping beliefs was measured by five items from The Coping Competence Question-
naire (Schroder and Ollis, 2013). This instrument had originally 12 statements, and we
used the 5 statements with the highest loadings from the factor analysis. All the state-
ments are formulated negatively and the variable score were turned before we made the
scale. Examples of statements: “When I do not succeed right away, I think I will never
get it”, “When I perform poorly at school, I begin to doubt my abilities”. Cronbach`s
alpha for the scale was good for both girls (.84) and boys (.87).

3.2.5 Appearance pressure

Appearance pressure was measured using two items based on a scale developed by
Skaalvik and Federici (2015). Examples of statements: “I have felt a strong pressure to
look a certain way in recent months”, “I have felt a strong pressure to dress in a special
way in recent months”. Cronbach`s alpha for the scale was good for both girls (.66) and
boys (.71)

3.2.6 School stress

School stress was measured using three items based on a scale developed for the inter-
national survey, Health Behavior in School-Aged Children (Samdal et al., 2016), organ-
ized and administrated by the World Health Organization. Examples of statements:
“I feel exhausted because of schoolwork”, “I`m stressed by schoolwork”. Cronbach`s
alpha for the scale was good for both girls (.79) and boys (.77).

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Girls suffer: the prevalence and predicting factors of emotional…

3.3 Data analysis

At first, we compared the full SDQ Emotional problems scale data with British
norm-data (Goodman et al., 2000), and compared this with a survey from 2000 that
included 19 210 adolescents from Norway (Rødje, 2004).
After this, an exploratory factor analysis was conducted on six sum scales (SDQ
emotional problems, academic self-concept, social self-concept, coping competence,
appearance pressure, and school stress) with a total of 23 statements (see Method
for details). Here we found that one item (“often complains of headaches, stomach-
aches or sickness”) in the SDQ Emotional problem scale loaded on the School stress
factor and decided to leave this factor out. This resulted in an exploratory factor anal-
ysis with a total of 22 statements. The Kaiser-Meyer-Olkin value was .89, exceeding
the recommended value of .6 (Kaiser, 1970; 1972) and Bartlett`s Test of Sphericity
(Bartlett, 1954) reached statistical significance, supporting the factorability of the
correlation matrix. Principal component analysis revealed the presence of six com-
ponents with eigenvalues exceeding 1. The six-component solution explained a total
of 68% of the variance. To aid the interpretation of these three components, oblimin
rotation was performed. The rotated solution revealed the presence of a simple
structure (Thurstone, 1947) with all six components showing strong loadings and all
variables loading substantially on only one component.
Furthermore, the hypothesized model of the connections between the variables
presented in Figure 1 were tested statistically to explore to what degree it was coher-
ent with the observed data. Structural equation modeling (SEM) in the AMOS 26
program was used to analyze the model with latent (unobserved) variables. None
of the error terms were allowed to correlate. The coherence between observed data

Fig. 1  Theoretical path model

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 J. A. Haugan et al.

and the hypothesized model is reported as the goodness of fit statistics. The good-
ness of fit indicators used to assess the model are Non-Normed Fit Index (NNFI,
also known as TLI), Comparative Fit Index (CFI), and Root Means Square Error
of Approximation (RMSEA), the study also includes chi square, RMSEA ≤ .07,
TLI ≥ .90, CFI ≥ .90 are considered as indicators of acceptable fit (Byrne, 2001; Hu
and Bentler, 1999). This indicates a plausibility of the associations between the con-
structs. The model was tested with the whole sample, and then separate analyses
were performed for boys and girls, because research indicates gender differences in
the importance of the hypothesized relation between constructs.

4 Results

4.1 Distribution of SDQ emotional problems

Table 1 shows the distribution of SDQ Emotional Problems through Upper Second-
ary School for both girls and boys. These are interpreted based on the original three-
band categorization from British norm-data (Goodman et al., 2000), and compared
with a survey from 2000 that included 19 210 adolescents from Norway (Rødje
et al., 2004).
British norm-data indicate that 90% of adolescents will score within the “Nor-
mal” (0–5), 5% within the “Borderline” (6), and 5% within the “Abnormal” cate-
gories. The 2000 survey from Norway (Rødje et al., 2004), shows that girls (11%)
reported abnormal levels of emotional problems almost three times as much as boys
(4%). In addition, girls (8%) reported borderline levels of emotional problems over
twice as much as boys (3%). Compared to the British norms we can conclude that
boys reported less emotional problems than expected, and girls reported about twice
as many abnormal and borderline levels of emotional problems.
Our data show that boys score about the same as expected from the British norm-
data and is distributed with almost exactly the same percentages as in the study from
Norway (Rødje et al., 2004). However, when interpreting the scores from the girls
in our study we can see another development. The girls report about four times as
many emotional problems as the British norms and as the boys in our study. In addi-
tion, we can see that the extent is almost doubled compared with the 2004 study and
that the emotional problems seem to increase as the girls grow older with 22% of

Table 1  Distribution of dependent variable SDQ Emotional problems in US1, US2 and US3 compared
with the Akershus study in 2000 and British norms by percentage
Three-band categorization British norms Boys Girls
2000 US1 US2 US3 2000 US1 US2 US3

Normal (0–5) 90 93 94 94 91 81 72 71 67
Borderline (6) 5 3 3 3 5 8 9 9 11
Abnormal (7-10) 5 4 3 3 4 11 19 20 22

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Girls suffer: the prevalence and predicting factors of emotional…

girls reporting abnormal levels of emotional problems in their last spring of Upper
Secondary School. In sum, these findings support H1.

4.2 Zero order correlations between observed variables

Zero order correlations between the study variables as well as N, range, number of
items, Cronbach`s alpha, statistical means, standard deviations and Cohen`s D for
boys and girls are shown in Table 2.
All correlations between emotional problems and the independent variables were
significant for both girls and boys. The correlations between the dependent variable
emotional problems and the independent variables academic self-concept, social
self-concept and coping competence were negative, ranging from r = −.20 to r =
−.57. This indicates that the higher the students perceive emotional problems, the
lower they perceive academic self-concept, social self-concept, and coping compe-
tence. The correlation between emotional problems and the independent variables
appearance pressure and school pressure was positive, indicating that the higher stu-
dents perceive appearance pressure, the higher they perceive emotional problems.
Most of the correlations between the observed variables are similar between girls
and boys, however the negative correlation between emotional problems and coping
competence seems to be stronger for girls (−.57) than for boys (−.38).
In addition, as the distribution of SDQ emotional problems in Table 1 indicated,
the means of the dependent variable were significantly higher for girls (3.53) com-
pared with boys (2.01). A similar difference is the mean for appearance pressure
(1.94/1.56) and school stress (4.32/3.58). An opposite pattern is shown for academic
self-concept (4.57/4.80), social self-concept (4.43/4.63) and coping competence
(4.07/4.72), with higher scores for boys compared with girls. Considering effect
size, Cohen (1988) claims that an effect of 0.2 is small, 0.5 is medium, and 0.8 is
high. The Cohen’s D measure thus indicates that the difference effect size is small
for academic self-concept (.29) and social self-concept (.22). Medium for coping
competence (.62), appearance pressure (.54), and school stress (.65). The effect size
is close to strong for the dependent variable emotional problems (.77).

4.3 Structural equation model

The relations between the variables were further analyzed by means of SEM anal-
ysis for latent variables using the AMOS 26 program as shown in the theoretical
model in Figure 1. The model had a satisfactory fit to data for both girls and boys:
CFI = .945/933, TLI = .931/915, RMSEA = .050/.053. Figure 2 shows the SEM
between academic self-concept (US I), social self-concept (US I), coping compe-
tence (US II), appearance pressure (US III), school stress (US III), and emotional
problems (US III), and Table 3 shows the direct, indirect and total effects, for both
girls and boys.
Figure 2 and Table 3 indicate that the correlation between academic self-concept
and social self-concept are positive (r = .51) for both girls and boys. Academic self-
concept and social self-concept in the first year of Upper Secondary School has a

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Table 2  Zero order correlations between observed variables (boys/girls)
Variables 1 2 3 4 5 6

SDQ Emotional Problems US3 – −.20**/−.26** −.28**/−.33** −.38**/-.57** .33**/.40** .38**/.44**

Academic self-concept US1 – .42**/.42** .32**/.40** −.05/−.17** −.19**/−.24**
Social self-concept US1 – .25**/.32** −.06/−.12** −.04/−.12**
** **
Coping competence US2 – −.30 /−.36 −.31**/−.41**
Appearance pressure US3 – .23**/.30**
School Stress US3 –
N 339/561 469/605 466/596 469/603 451/585 403/558
Range 0-8 1-6 1-6 1-6 1-4 1-6
Number of items 4 4 4 5 2 3
Cronbach`s alpha .71/.73 .80/.82 .89/.86 .84/.87 .66/.71 .79/.77
Mean 2.01/3.53 4.80/4.57 4.63/4.43 4.72/4.07 1.56/1.94 3.58/4.32
SD 1.76/2.13 .76/.83 .94/.87 .97/1.11 .62/.77 1.17/1.12
Cohen`s D .77 .29 .22 .62 .54 .65
**
p<.01
*
p<.05
J. A. Haugan et al.
Girls suffer: the prevalence and predicting factors of emotional…

Fig. 2  Structural Equation Model between Grades, academic self-concept, social self-concept, coping
competence, appearance pressure, school stress, and emotional problems divided by gender (boys/girls).
(Color figure online)

Table 3  Direct, indirect and Variables Effects

total effects in the Structural
Equation Model for boys/girls Direct Indirect Total

Academic Self-concept (USI)

Coping Competence (USII) 29/.32 – 29/.32
Appearance Pressure (USIII) – −.11/−.16 −.11/−.16
School Stress (USIII) – −.10/−.16 −.10/−.16
Emotional Problems (USIII) – −.13/−.20 −.13/−.20
Social Self-concept (USI)
Coping Competence (USII) .17/.19 – .17/.19
Appearance pressure (USIII) – −.07/−.10 −.07/−.10
School Stress (USIII) – −.06/−.10 −.06/−.10
Emotional Problems (USIII) −.21/−.17 −.07/−.12 −.28/−.29
Coping Competence (USII)
Appearance pressure (USIII) −.36/−.50 – −.36/−.50
School Stress (USIII) −.36/−.51 – −.36/−.51
Emotional Problems (USIII) −.18/−.31 −.26/−.31 −.44/−.61
Appearance pressure (USIII)
Emotional Problems (USIII) .30/.25 – .30/.36
School pressure (USIII)
Emotional Problems (USIII) .39/.36 – .39/.25

13
 J. A. Haugan et al.

significant direct positive association with coping competence in the second year
of Upper Secondary School (β girls/boys = .32/.29 and .19/.17, respectively), and
explains 20% and 16% (girls/boys) of the variance in the coping competence vari-
able. Table 3 indicates that the two self-concept variables have indirect effects on
appearance pressure, school stress and emotional problems. However, we could not
find any direct significant relationships between the self-concept variables and the
perception of appearance pressure and school stress. In addition, of the two self-
concept variables, it is only social self-concept that has a direct negative relationship
with emotional problems (β girls/boys = −.17/−21).
Coping competence has a significant direct negative relationship with appearance
pressure (β girls/boys = −.50/−.39), school stress (β girls/boys = −.51/−.36), and
emotional problems (β girls/boys =−.31/−.18) for both girls and boys, respectively.
In addition, Table 3 indicates that coping competence also has a considerable indi-
rect effect (β girls/boys =−.31/−.26), on emotional problems through appearance
pressure and school stress, resulting in a total effect of β =−.61 for girls and β =−.44
for boys. The model explains 25% (girls) and 15% (boys) of the variance in appear-
ance pressure, and 26% (girls) and 13% (boys) of the variance in school stress.
Both appearance pressure (β girls/boys =.25/.30) and school stress (β girls/boys
=.36/.39) have a significant positive relationship with emotional problems for both
girls and boys, respectively. In all, the structural equation model explains 63% of the
variance in emotional problems for the girls, and 49% for the boys.

5 Discussion

The primary goal of this study was to further explore the prevalence of emotional
problems, and a proposed pathway between emotional problems among Upper Sec-
ondary School students, and their perceptions of academic self-concept, social self-
concept, coping competence, appearance pressure and school stress. The following
research question guided the study: “To what extent do students in Upper Secondary
School experience emotional problems, and how are these problems predicted by
gender, academic/social self-concept, coping competence, appearance pressure and
school stress?” Based on this research question and our findings from the literature
review, six hypotheses were formulated, and a theoretical path model was specified.
Our findings mainly confirmed previous studies.
The first main finding is that the prevalence of emotional problems among ado-
lescents has increased considerably compared with the 2000 survey from Norway
(Rødje et al., 2004). This supports H1 and previous research (Bor et al., 2014; Choi,
2018). However, even though it is expected, the large effect size difference between
boys and girls is somewhat surprising. The zero-order correlations between the
dependent and the independent variables reveal that the relationships are somewhat
the same for both girls and boys, with the exception of the association between emo-
tional problems and coping beliefs (competence). This relationship is stronger for
girls compared to boys, indicating that girls may be more vulnerable for develop-
ing learned helplessness (Abramson et al., 1978; Schroeder and Ollis, 2013). This
notion is supported when analyzing the Cohen’s D effect size difference between the

13
Girls suffer: the prevalence and predicting factors of emotional…

genders. Girls perform significantly higher than boys in Lower Secondary School,
but still they have lower academic self-concept and social self-concept. In addition,
the coping belief, measured as coping competence, is considerably lower for girls
compared to boys, while the perception of appearance pressure and school stress
are higher to the same degree. This imbalance may explain the high effect size dif-
ference in emotional problems. In sum, this finding corresponds well with other
research that has found that girls are at greater risk of developing emotional prob-
lems, reporting lower levels of self-concept, coping beliefs, appearance pressure and
school stress (Caprara et al., 2010; Muris et al., 2015).
The other main finding is that the proposed pathway in the theoretical model pre-
sented in Figure 1 had a good fit with the data, especially for girls, as it explained
63% of the variance in emotional problems. This indicates that academic self-con-
cept and social self-concept, coping competence, and the perceptions of appear-
ance pressure and school stress predicts emotional problems among adolescents in
a prominent manner. In support of earlier research, the correlation between the self-
concept variables was high (Marsh and Craven 2006; Marsh and Martin, 2011). In
addition, Shavelson et al.`s (1976) theory on the multidimensional nature of self-
concept was underlined by our finding about the difference of whether, and with
what strength, academic self-concept and social self-concept predicted the other
variables in the model. As expected, the self-concept variables predicted the adoles-
cents’ perception of coping competence in USII in similar strength for both girls and
boys. This supports H2, H3 and previous research (Craven and Marsh, 2008; Marsh
and Martin, 2011). Furthermore, it was expected that social self-concept in USI was
significant for both girls’ and boys’ perceptions of emotional problems in USIII.
However, in contrast with previous findings on the longitudinal effects academic
self-concept has on emotional problems (Craven and Marsh, 2008; Marsh and Mar-
tin, 2011), we could not find any significant direct negative association to emotional
problems, even though there were some indirect effects through coping beliefs. This
finding is surprising and needs further scrutiny in future research
Another interesting finding from the structural equation modeling is that coping
competence has a significant negative relationship with appearance pressure, school
stress and emotional problems for both girls and boys. However, the strength of
these direct and indirect associations is somewhat stronger for girls compared with
boys, indicating that coping competence seems to be important for both genders,
and most important for girls, when it comes to predicting perceptions of pressure
and negative health outcomes. These findings support H4 and previous research
(Sowislo and Orth, 2013; Yeoh et al., 2017). In addition, in support of H5, H6 and
previous research (Alm and Låftman, 2018; Bearman and Stice, 2008; Låftman
and Modin, 2012; Ringdal et al., 2020) appearance pressure and school stress had
a direct and positive relationship with emotional problems. However, it was more
surprising that these associations were somewhat stronger for boys compared with
girls, even though the differences were small.
In sum, the findings can be discussed in light of other studies that have shown
that the level of coping beliefs plays a significant role in how different kinds of per-
ceived demands are experienced (e.g. appearance pressure and school stress), and
affects the risk that stress leads to emotional problems (Caprara et al., 2004; Shelley

13
 J. A. Haugan et al.

and Pakenham, 2004). Several studies conclude that increasing individuals` cop-
ing beliefs and expectations of coping may reduce the negative effect of the various
stressors we are exposed to (e.g. McKay, Dempster and Byrne, 2014). In a longitu-
dinal study, Burger and Samuel (2017) investigated how perceived stress and cop-
ing beliefs play a role in influencing adolescents` satisfaction with life. They found
that perceived stress was negatively correlated with life satisfaction, whereas the
opposite was true of coping beliefs. In addition, the individuals` basic expectation
of coping further moderated the negative effects of stress. Thus, a high level of cop-
ing beliefs neutralized the negative effects of stress on adolescents` satisfaction with
life. Furthermore, our coping beliefs today are related to the coping experiences we
have had in the past (Groth et al., 2019; Samdal et al., 2017). A situation where
we are exposed to stress stimuli can result in both positive and negative response
outcomes. Positive outcomes represent situations in which individuals experience
mastery. They have experienced being challenged, but also that they can cope with
it. Negative outcomes are characterized by individuals experiencing that they do not
cope. At worst, they will experience helplessness (“I can`t do anything about the
situation”), and hopelessness (“things go wrong anyway and it`s my own fault”) (cf.
Abramson et al., 1978; Schroder and Ollis, 2013). A number of such negative out-
comes contribute to both low coping beliefs and sustained stress activations, which
in turn can lead to negative health outcomes.

5.1 Perceptions of internal/external demands/resources as predictors

of emotional problems

Why do we observe this recent increase in mental health problems? How can this be
explained? In light of Lazarus and Folkman’s (1984) transactional model of stress
the causes of mental health problems can be placed in two main groups: resources
and demands. These can each be further divided in two: internal and external. To
maintain emotional health, resources and demands have to be perceived as balanced
by the individual. Thus, to reduce emotional health problems, we have to consider
how we can enhance the adolescents’ perceptions of internal and external resources,
and reduce the perception of internal and external demands.
Considerable research has investigated how to enhance adolescents’ internal
and external resources, especially in a school context. The first meta-review over
research on mental health promotion and problem prevention in schools was con-
ducted by the European Union Dataprev project (Weare and Nind, 2011). This pro-
ject included 52 systematic reviews and meta-analyses of mental health in schools
and the results show that interventions have a wide variety of beneficial effects
on children, families and communities on a range of social, emotional and educa-
tional outcomes. A conservative estimate from the London School of Economics
and Public Health England shows that for every pound Britain invests in social and
emotional learning (SEL) school programs to prevent depression among children
and young people, the UK saves five times the investment cost in just two years
(McDaid et al., 2017). These findings were supported by a meta-analysis of 81 stud-
ies compromising 31 974 school students (Werner-Seidler et al., 2017), and another

13
Girls suffer: the prevalence and predicting factors of emotional…

meta-analysis of 82 school-based social and emotional learning programs (Taylor

et al., 2017). Although the effect sizes are small, these studies provide solid evidence
that mental health can be strengthened, and emotional problems can be prevented,
through school measures. The best-tested school programs are based on social and
emotional learning, cognitive-behavioral, or multifamily therapy (MFT). A meta-
analysis of 146 RCT-studies found that it is not sufficient to disseminate informa-
tion only, e.g. through teaching materials or with educational or psycho-educational
measures (Stockings et al., 2016). Research suggests that the measures should also
contain a psychological component with an element of practice, such as training in
cognitive techniques. In addition, Mendelson and Eaton’s (2018) meta-analysis indi-
cates that internet- or computer-based prevention strategies and mindfulness-based
interventions are promising areas for further development and need further research.
On the other hand, there are a number of increased internal and external demands
that twentifirst century adolescents experience that potentially can have nega-
tive consequences for their emotional well-being by contributing to the increas-
ing prevalence of mental health problems (Bor et al., 2014; Seiffge-Krenke et al.,
2009). For adolescents living in a world characterized by rapid changes and tech-
nological advancement, it is important to understand that different trends and fac-
tors can be related to their emotional well-being and ill-being. This does not mean
that the fundamental elements of mental health have changed. However, as a result
of various contexts and the environment that children face today, different trends
arise, and accordingly various approaches exist to mitigate the negative effects. An
example is the Programme for International Student Assessment (PISA), that was
introduced for the first time in 2000. This was aimed to provide a “global” compari-
son across nations to determine the relative quality of each country`s educational
system (OECD, 2001). This cross-national comparison led to considerable debate,
especially among the countries with the lowest scores, and facilitated reforms in
educational policy and practice, and enhanced expectations, demands and com-
petition among schools and students (Cosma et al., 2020; Klinger et al., 2015). In
addition, several theorists argue that too much responsibility and accountability has
been placed on the internal and individual. Research has found a rise in internal per-
fectionism expectations and demands connected to both school and appearance that
may contribute to increases in stress and subsequent mental health problems (Cosma
et al., 2020; Curran and Hill, 2019). This finding is in line with the individualiza-
tion thesis that is based on the idea that collective identities associated with class,
family and gender are weakened in favor of individual aspirations that have become
more important (Beck, 1992). This notion is relevant for the increase in emotional
health problems in several ways. First, it is up to each individual to create their own
future, find out “who one is”, set goals, and reach them (Giddens, 1991; Illeris et al.,
2009). Consequently, the responsibility for success and for one`s own destiny also
increases, especially within the school system. Second, the individualization thesis
is relevant in this context because mental health problems themselves may be under-
stood to be more individualized than before. While conditions such as neurasthenia,
melancholy, sadness and nervousness were perceived as a consequence of culture a
hundred years ago, it is claimed that similar conditions today are to a greater extent
interpreted as a weakness of the individual.

13
 J. A. Haugan et al.

Overall, our analyses of the two pressure areas: school and appearance, indicate
that girls are more vulnerable than the boys. In both of these areas, the pressure
is more closely associated with emotional problems among girls than boys. Thus,
this indicates that school stress, pressure related to appearance, and coping beliefs
is potentially a greater health risk for girls than for boys. One possible explanation
is that girls, to a higher degree than boys, reflect their intrinsic value on how they
succeed in school (Esnaola et al., 2018; Låftman and Modin, 2012). There is also
reason to believe that the perception of personal appearance is more important for
the girls` self-image than for boys (Alm and Låftman, 2018; Esnaola et al., 2018).
Although many argue that the ideals for body and appearance also have changes for
boys (Bassett-Gunter et al., 2017; Karazsia et al., 2017), these findings indicate that
looking good is still more important for girls compared with boys. Thus, it may be
that girls actually experience more pressure in these areas, and also interpret the
pressure as more threatening to their own identity. Because external stressors are
perceived and interpreted subjectively, based on personal values, the social roles we
hold, and from past experiences, the same amount of actual demands and expecta-
tions can be experienced without problems for some and pose a health risk for to
others (Avison, 2010; Thoits, 2010). At the same time, the potential for experiencing
a situation with a lot of pressure such as stress may be explained by gender differ-
ences in the amount of resources available in the situation and to differences in the
coping strategies available to girls and boys. However, other research indicates that
the suicidal rates are far higher among men compared with women (Oliffe et al.,
2016; Rasmussen et al., 2017). This may indicate that stress and emotional problems
among adolescent boys are underreported. Thus, we need more research to inves-
tigate long-term effects of perceptions of demands and resources across genders
through childhood, adolescence and adulthood.

5.2 Limitations and future directions

This study has some limitations that should be acknowledged. First, all data were
based on students` self-reports. Future studies should employ more objective meas-
ures of the social environment (e.g. behavioral observation), triangulate subjective
perceptions (e.g. different informants such as friends, parents, teachers, coaches
etc.), and make use of both quantitative and qualitative methods. Second, the data
from this study are limited to the school context. Future studies should test the
associations between environmental factors from several micro-systems, subjective
needs and adolescents` emotional health via longitudinal and experimental designs.
Third, this study has only considered individual-level variables, without considered
the effect of the differences between social classes and schools on perceived ecology
with relation to emotional health among individuals. Several studies have revealed
that differences in the classroom or school environment exist across school level
(e.g. Danielsen et al., 2010; Wang et al., 2018). Future studies may consider using
a multi-level modeling approach to study the impact of class-, school- and societal-
level factors.

13
Girls suffer: the prevalence and predicting factors of emotional…

Despite these limitations, the results in our study may have important clinical impli-
cations for current interventions aimed at preventing and reducing mental health prob-
lems in school. Our findings suggest that targeting perceptions of self-concept and cop-
ing beliefs will reduce feelings of pressure, stress and emotional problems. Integrative
interventions should focus on enhancing adolescents` self-concept and coping beliefs
as early as possible to disrupt any potential detrimental cascading effect on mental
health. This is in line with the findings of intervention studies that reveal that coping
beliefs seems to be an important mechanism to improve mental health outcomes (Ken-
dall et al., 2016; Ohannessian et al., 2019).
A comprehensive understanding of pressures and stress among young people today
should include knowledge of who is the agent behind the significant amount of pres-
sure young people experience in everyday life. Adolescents can be both passive recipi-
ents of experienced pressure and active agents that exercise resistance. Knowledge
about the various actors is not least important. Thus, teachers, counsellors and schools
should aim to find good methods and structures that reduce the amount of pressure
or make youth more robust against the pressure they experience in everyday life. To
what extent do adolescents themselves contribute to the pressure they experience, and
to what extent are they actors in reducing the pressure? Is this the solution to teaching
each one to prioritize better in their own lives? To what extent and in what arenas do
adults, such as parents, teachers, coaches, school authorities and commercial advertis-
ers have a responsibility? And to what extent does pressure from the adult community
work together with peer pressure—both analog and digital—to increase the amount of
pressure and the vulnerability of that pressure? These are important issues for the social
debate and should be explored further in future research.
Several replication studies are needed that can confirm, disprove, or nuance find-
ings from earlier studies. Studies with multiple data sources are needed, such as inter-
views with parents, teachers, counsellors and school leaders, which can be combined
with self-reported data. Future research should also examine a longer-term follow-up of
comprehensive data on prevalence and outcomes, encompass more high quality rigor-
ous randomized control trial designs with comparable control groups, and also study
the potential effectiveness and feasibility of teachers delivering these program sessions
and training. The aspect of investigating teacher delivery of efforts to improve students’
mental health is important. As several studies have pointed out, teachers can play a
vital role in delivering such prevention programs. Future studies should also investigate
the practicality of implementation in terms of costs, additional burden on teachers, and
the necessary support that teachers need to deliver this training and programs. In order
to prevent an increase in teachers’ workloads, which can reduce a teacher’s emotional
well-being and in turn that of students, it will be important think about ways in which
social and emotional learning can be incorporated into the curriculum and existing day-
to-day learning activities.

13
 J. A. Haugan et al.

6 Conclusion

Although this study has some limitations, the results in the present study under-
score the need for research on self-concept, coping beliefs and environmental pres-
sure when it comes to understanding adolescents’ coping and emotional problems.
In sum, our findings can be illuminated in light of other research that has suggested
that girls perceive more pressure than boys and at the same time are more vulner-
able to the effects of this perception (Bakken et al., 2018; Hankin et al., 2008). Thus,
girls perceive their external and internal demands as higher than boys but their
external and internal resources are perceived to be lower. In light of the transactional
theory of stress (Lazarus and Folkman, 1984) and the theory of learned helpless-
ness (Abramson et al., 1978), these unfortunate connections may explain why girls
are developing higher levels of emotional problems. These findings are of great sig-
nificance for practical implications and applications. Teachers, counsellors and the
school as a whole should increase their effort to facilitate the development of psy-
chological resilience as this seems to be both a decisive protective- and risk-factor
when it comes to adolescents’ sense of stress and emotional well-being, especially
among girls.

Funding Open access funding provided by NTNU Norwegian University of Science and Technology
(incl St. Olavs Hospital - Trondheim University Hospital). The authors received no financial support for
the research, authorship, and/or publication of this article.

Declarations

Conflict of interest The authors declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Informed consent Informed consent was obtained from all participants, Additionally, parents were sent
an information letter with the option to opt their child out of the study. The study was approved by the
Norwegian Data Inspectorate

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as
you give appropriate credit to the original author(s) and the source, provide a link to the Creative Com-
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Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published
maps and institutional affiliations.

Jan Arvid Haugan is an Associate Professor at the Norwegian University of Science andTechnology. His
research interests are the development of social relationships, stress, copingand well-being within and
across different microsystems in adolescents life-ecology,especially the microsystems related to sports
and education.

Per Frostad is a professor at the Norwegian University of Science and Technology. Hisresearch interests
are social inclusion, mental health and wellbeing in upper secondaryschools.

Per Egil Mjaavatn is an Associate Professor at the Norwegian University of Science and Technology. His
research interests are everyday life and wellbeing among children and youth, students’ opinions about
their physical and mental health, social relations and their experiences in the education system.

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